Clear Channels: Ensuring Effective Endoscope Reprocessing
October 1, 2010 | Evaluations & Guidance
In December 2008, U.S. Department of Veterans Affairs (VA) investigators discovered that staff at one of their facilities were not following manufacturer recommendations when reprocessing the auxiliary water tubing and other irrigation accessories on colonoscopes between patient procedures, creating the potential for contaminants from one patient to enter subsequent patients. This problem was even more alarming because, during at least some colonoscopies, tubing with an incorrect valve had been used to connect the colonoscopes to the flushing pump—an error that could allow backflow of body fluids into the irrigation system. This could further increase the contamination risk for the tubing that was not being properly reprocessed. Following the investigation, similar announcements were made by three other VA hospitals regarding inadequate reprocessing of certain endoscopes and accessories (ECRI Institute 2009 Apr 17, VA 2009).
Subsequently, more than 10,000 patients were informed that they might have been exposed to bloodborne pathogens during colonoscopies due to improper reprocessing of endoscopy equipment and accessories. The VA offered free testing of notified patients, and over 50 patients tested positive for hepatitis B, hepatitis C, or human immunodeficiency virus (HIV). It is not known how many, if any, of these cases were the result of improper reprocessing.
More recently, officials at Palomar Pomerado Health System (PPHS) discovered during a routine internal oversight process that employees were repeatedly using expired disinfectant solution to disinfect certain endoscopic equipment. Investigation by state officials revealed that a delay in the arrival of new disinfectant solution had led employees to use expired solution, putting 45 patients at risk of infection (Clark 2010, Garrick 2010).
The events at the VA hospitals and PPHS are just recent examples of endoscope reprocessing problems that have plagued many healthcare institutions over the years. These incidents highlight the dangers of improper reprocessing of flexible endoscopes and their accessories. They also illustrate why such problems continue to occur: Put simply, reprocessing endoscopes is a complicated matter.
Flexible endoscopes are used to perform minimally invasive diagnostic and therapeutic procedures. These devices can be guided through narrow winding routes, such as the digestive tract and blood vessels, to allow physicians to view and access internal body structures less invasively than would otherwise be possible. Because they are used within the body, flexible endoscopes become contaminated during use. Thus, between uses they must be reprocessed to...